Dr. Jay Tarnow and Dr. Ron Swatzyna continue to be on the leading edge of mental health treatment with their newest publication. In November 2016, the Journal of Clinical Neurophysiology accepted the article “Integration of EEG into Psychiatric Practice: A Step Toward Precision Medicine for Autism Spectrum Disorder.”
Following the National Institute of Mental Health’s (NIMH) Research Domain Criteria (RDoC) project, the study sought to further research on evidence-based interventions in psychiatry and step away from medication recommendations based on trial and error. Specifically, Drs. Tarnow and Swatzyna wanted to prove that integrating the EEG into psychiatric practice can provide valuable information for treatment and medication selection.
Although it is not common for the EEG to be used by psychiatrists, past research has found that EEG abnormalities are more prevalent in psychiatric patients when compared to the general population. In particular isolated epileptiform discharges (IEDs) are found to be more prevalent in those diagnosed with Autism Spectrum Disorder (ASD), ADHD, and Tourette’s syndrome.
ASD often presents a treatment challenge, due to the variety of symptoms that make each case unique. Many medications prescribed to manage associated symptoms such as attention issues, anxiety, depression, poor reality, testing, and behavioral problems fail to alleviate symptoms and produce undesirable side effects. In addition, these medications lower seizure threshold, and result in increased epileptiform activity. Therefore, it may be prudent to order an EEG prior to treatment in order to screen for EEG abnormalities that may otherwise go undetected.
The study was comprised of 140 nonepileptic subjects diagnosed with ASD, ages 4-25. The majority of the subjects were referred for treatment after failing multiple attempts with different medications. Visual inspection of each of the subject’s EEGs was performed in order to search for abnormalities.
Of the 140 subjects with ASD, the EEG data identified 36% of the subjects had IEDs. There were no significant differences found between genders or age. These findings indicate that there is a high prevalence of IEDs among individuals with ASD.
In conclusion, the results show that compared to a healthy population, a large number of patients with ASD have IEDs. These findings suggest that an EEG should be utilized with children, adolescents, and young adults with ASD, regardless of gender or age. This is particularly true for those who exhibit aggressive behaviors or those who have failed prior medication attempts with stimulants, antidepressants, and antipsychotics. Utilizing the EEG for refractory cases in a psychiatric practice allows for more individualized and precise medication selection.